ED raatezi “ a> Bora Afya Leo ni Uzima Kesho Seb Isl wiensimu wa Lishe Bora 1. NUTRITION ‘A. COMPLEMENTARY FEEDING (1) preparation DHMT/Health focility in-charges to: 1. Identify one or two people to conduct the demonstration at each facility, 2. Identify a ‘demonstration corner’ in the compound. This should be an area that is easily accessible to those coming to access services during the CHNW ~ men, women and children. Ensure adequate seating for 15 -20 people. 3. The nutritionist or other designated person should obtain fresh supplies of foodstuffs for the demonstrations e.g fruits, vegetables, legumes, cereals, starchy roots/tubers, animal proteins. 4. Identify a mother who has exclusively breastfed to share their experiences. These can be identified from mother support groups where they exist, 5. All health workers briefed fo refer and encourage people go to the demonstration comer 6. DHS fo ensure that equipment and supplies necessary to conduct demonstrations are provided (Il) interactive teaching and discussion se (Person responsible for the demonstrations to facilitate the following) 1. Ensure that equipment and supplies necessary fo conduct demonstrations are available and ‘assembled at the beginning of each day. 2. Once 15 — 20 people are seated commence with presentation/discussion followed by the demonstration, 3. Make a 10 — 15 min presentation on breast and complementary feeding emphasizing the following key messages. (a)mportance of exclusive breastfeeding for 6 months and dangers of early complementation Highlight benefits of EBF for infants, mothers and communities and how to ensure an adequate supply of breastmilk (b)Importance of continued breastfeeding (on demand) for at least 24 months after introduction of complementary feeds at 6 months.‘simu wa Lishe Bora (c) Importance of providing energy and micronutrient dense feeds to complement breast milk from 6 months. (d)importance of giving small feeds frequently and actively to infants and young children to enable them meet daily requirements. {e} Importance of observing hygiene in food preparation, feeding and storage. During the discussion sessions: * Use the chart on ‘How to Feed Young children well’ or other available resources to illustrate the messages. + Ask mothers who hos exclusively breasifeed fo share her experience with the audience. * Allow time for questions affer the presentation (See summary of frequently asked questions on exclusive breastfeeding, complementary feeding and IF by mothers who are HIV positive} (It!) demonstration 2 Demonstrate preparation of nutritious complementary feeds using locally ovailable foods. During the demonstration: 1. Show examples of foods rich sources of energy, protein, vitamins/minerals. 2. Emphasize importance of hygiene in food preparation, serving, feeding and storage 3. Explain how to minimize loses of vital nutrients especially water-soluble vitamins during prepare and cooking of foods 4. Explain how to enrich complementary feeds to make them energy and micronutrient dense. 5. Show how to store baby feeds hygienically 6. Give mothers/caregivers handbills with key messages on breast and complementary feedingB. GROWTH MONITORING & PROMOTION All children 0 - 59 months should have their weight token and recorded on child’s health card ond ‘on monitoring tool (CHANIS) + Ask the mother to undress the child and remove heavy moterials With the assistance of the mother place the child in the infant weighing scale or in the pants of the spring scale making certain the strap of the pants. is in front of the child. Attach the strap to the hook of the scale and the child should hang freely * Hold the scale and read to the nearest 0.1 kg when the indicator on the scale hes stabilized at eye level. * Plot weight observed weight on child’s health cord ‘and on monitoring tool‘Msimu wa Lishe Bora Look for oedema of both feet (a clear indentation on both feet after pressing for 3 seconds) Children with severe wasting appear to have very little or no muscle or fat around the thighs and buttocks giving a ‘baggy pants’ appearance. Look for palmar pallor. Detecting and Managing Malnutrition All children 0-5 years should be checked for the following signs of malnutrition.€. BREASTFEEDING Establish breastfeeding practices by the mother. Orme eer eat ACR BER uel RUT Re Rca Ric Luror Whether child is breost fed ot night or not RAC menT ORS oes Re Ua RUC ele toa Mo DCCL RL RAR oa elt] Be Whether child is fed on any other foods or fluids and which these are and how frequently. Corrective action * Give appropriate information to mothers to support exclusive and continued breastfeeding. Children 0-6 months should be exclusively breastfed: No feeds (including water) other than breast milk only. Breastfeeding should be on Cerne ach oa CR Ren) Encourage breastfeeding during illness. If child is not able to breast feed, Caer sr ae ean kc | at Encourage increased fluid intoke for older children, including breastfeeding, COMO na Cmen Kune Rm Clin meena Rt ons acu acsimu wa Lishe Bora D, VITAMIN A SUPPLEMENTATION HOW TO DECIDE IF A CHILD NEEDS VITAMIN A SUPPLEMENTATION LOOK: AT THE CHILD'S AGE ON THE CHILD HEALTH CARD. ASK THE MOTHER IF THE CHILD HAS RECEIVED VITAMIN A IN THE LAST 6 MONTHS. Ifthe mother answers VES ld is older than 6 months please congratulate the mother. mother answers NOz And the child is older than 6 months give vitamin A as per schedule below. Vitamin A protocols Vitamin A is given orally every 6 monthsMsienu wa Lishe Bora ‘Confirm age of the child foe reed iy Key messages for coregivers on Vitamin A All children aged 6 to 59 months need a vitamin A capsule every 6 months. Vitamin A supplementation is safe for children and protects them from diseases such os diarrhea, acute respiratory infections and olso reduces deaths. Children should be fed as often as possible with vitamin A rich foods (mangoes, green lealy vegetables, wild red cand orange fruits, egg York, liver, milk, etc) Children sick with measles, certain eye problems, severe diarrhea or severe malnutrition should visit health centers because they may need additional Vitamin A according to the treatment schedule.(Msimu wa Lishe Bora 2. MANAGEMENT OF THE SICK CHILD A. SICK CHILD RECORDING FORMS: Below are recording forms for: + Management ofthe sick child aged 2 months up to 5 years. + Management ofthe sick young infant up to 2 months. PU eee Ce CRY Nome: ASK: Whot are te ci’ problems? Age Weighs CLASSIFY kg Temperoture:_0¢ Follow-up Visit ‘HECK FOR GENERAL DANGER SIGHS NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING HISTORY OF CONVULSIONS, LETHARGIC OR UNCONSCIOUS ‘CONVULSING NOW ‘Genarl donges signs presenté Yex__No__ Remember tose danger sgn hen selecing clesictions ‘DOES TAF CD MAVE COUGH OR DIFFICULT BREATHING? + Ferhowlong? Days Yes___No__ “+ Count the breaths in one minute ‘breaths per minus. Fos breathing * Took for chest ncrowing * Look and listen lor sidar * Leck and listen fr wheeze, ‘DOES THE CH HAYE DIARRHOEA? For how long?__ Days {tether blood inthe stoolet Yee Neo + Look at he ci lethe cil: sLethorge o unconscious? Rests or ritoblat * Look for sunken eves ‘Ofer the child Fla. Is the chi [Notable to drink ox drinking poorly? Drinking eager this? + Pinch the skin o the obdomen. Does it go beck Very lomiy longer than 2 seconds) Slowly? 's generol condition.Msimu wa Lishe Bora: ‘Does Tecnu Have FEVER? (yay op 7 al) Ayes, asthe child vist high moro ore in the ast 1 manne Dede Molar Rss High tow + Forhon long Dow ‘+ hmore han 7 dys, hos fever been present every doy? + Hor child had mecale whine lan tree month? ifthe child hos measles now or within the lst 3 month Yer__No__ + Look o fel fr si eck. * Look for runny noe, Look for sgn of MEASLES: * Generated rsh ond *+ One of hse: cough, runny nose, ord ees, * Look for mouth vicars IWYes, are they deep ond extensive? Look for pus reining Yom the eve * Look or clouding of the corneo, + Is there oor point + Isthere oor sachovget Iryes for how long? Doys Yer__Neo, * Look or put draining from the ear. “Fee for tender sweling behind the eo ASK: ethers history of TB contac. Lock for viable svere wasting, ook fr paler pall ‘Severe palmar colo? Some palmar Pallor? ook fr oedema ofboth fet + Determine weight for age: Very tow Not Very Low + Look ofthe chia's Heath Cord determine ‘rom pater {shore Growth fering? (Weight curve fatening oF dropping frat ees! 2 consecutive months) ‘CHECK FOR SUSPECTED SYMPTOMATIC HIV INFECTION + Is there history of TBin ary porent in the lost 5 yeorst “+ Hos the child ever hod two oF more episodes of diarrhoea lesing 14 days or moret + Does he child have fos beating cr chest ind-awing? 1s thor growth falloring ox weight below the ‘very low weight cure? * Look fr enlarged lymph nodes two or moreo he {ollowng ster? Neck, aloe, goin + Look for oral thrush * Determine mothers HV tli: Reactive Non reactive UnknownsMsimu wa Lishe Bora CHECK THE CHILD’S IMMUNIZATION (Gree immunizotions end vtein A supplements AND VITAMIN A STATUS. needed today. GFFR@pEHE DPTFecBHb2 ‘DFTHepERE S| SMonihs {Morhe \8Monhe 24 Monte Rotun for net immunization oF Vitamin A supplementation on (Date) OPID ONT ON2 ONS. Near Wlowiewer | 30Monfs 36ers @2Wonhs 4B Norte 80 ond Yellow fever ore lve voccins ond should therfore | 54 Monihs 80 Months rot be giver to an inmunesuopresed cid, 9, AIDS Immunuzation schedule ‘Schedule for Vitomin A supplementation ASSESS CHILD’S FEEDING FEEDING PROBLEMS + Do you braseed your child? Yr__ No IF Yes, how many tmes during the day?___Do you breasted during he nigh ® Yes_No__ How mony mes? FF you do no! breasted, why sal z ‘Does the cd tke any char fod or Midst You No IF ¥es what foods orice ‘Fw many ves por day? Teves. Whol do you ae 1 eed the cRIdR verylow wight for og, ak How loge oe soning zi lethechid saved an her avn plated Yes No__who feeds ha child ond how? ‘During he ines, hos he chile’ feeding changed? Yes No, HYG how? [ALSO ASSESS CARE FOR DEVELOPMENT ‘CARE PROBLEMS ‘+ How do you play with your child + How do you eommunizat with your ASSESS OTHER PROBLEMS:Msimu wa Lishe Bora MANAGEMENT OF THE SICK CHILD AGE UP TO 2 MONTHS Nome oe Wisin ASK: Whot are the info’ problems? Inlet [ASSESS (Circe al signs presen) CLASSIFY (OH FOR VERY SEVERE DISEASE * Look or breathing the baby gosping cr not breathing a al eran when simvoted Hes he infnt hod comaions? + Count the broths in one mine, ___ breaths ar minute lcthe info able a fed or breasted? Repeat i elevoted Fast breathing? + Look for severe chew ingrown, * Look fr nasal fring. ‘lock ond listen for grunting or wheeing, * Lock nd fea! fr bulging Fontan ‘Lock for pus dein hom he woe } ‘lock ot ubilcve, fred or droning pus? ‘Fever lemperatre 37 SOC or fees ho) or low bedy temperature i [bxlow 35 50C or fee coo) _ ‘lock for skin putes. 1 Sef young nfs lthargi or unconscious. ‘look ot young infon's movernants. Ne movement even when simuloted (HFC FoR AUN Dees the young infant have yellow discolouration of Yoo__No, the skint yes for how long? Doys Look a the young infants palms ond soles ‘Ae the pols ond sles yellow? ‘CHECK oR EYE FECTION Isthore eye dichorget Yos__No For how long Doys Look athe young infonts eer ‘Are the eyes draining oust Eyes swollen?Msimu wa Lishe Bora ‘DOES THE YOUNG NANT HAVE DIARENOEA? Yer__Ne. + Look o! the young infant's general condition. Is the infont: + Forhow long?__ Dove Lethoraie or unconscious? {isthe blood inthe stools? * Reales or iitoble? * Leak for sunken eyes. {Pinch the skin ofthe abdomen. Does it go bock + Wer slowly longer than 2 seconds Slowly? + lathe infont breastfed? Yes__No__ 1 Doferine mothers HIV status: Reocive IF YES, how many times in 24 hourst Non reactive During the 6. Unknown During he night ENO, why, + Does the infant val receive any ther foods or crinkst Yer No YES, Row offen? pies How de you pepore the Teede 2 What de you ute 0 fed he id? 1 the infont hos ne indications for urgent referral to hospital from the previous assessment: [ASSESS BREASTFEEDING: + Hos info rested nthe previous hurt infor hos rte inh previous hou, ok he carlo phere othe breast. Observe the breasted for 4 mines + sth inant comet pesiined Tea cack or corre pstioning look for Yes__No__ + Init bleo otc Te chuck tome, sco = ols od ond body sight Yes__No__ Chin touching breast Yes__No__ fot facing te moter wth rose oppose he ripple Yes No — Mouth wide open Yes Ne ~ Infor’ bed los the mars body Yes No tower ip ued outward YeNo | ater supporing infor’ whole body od nota neck Yen__No_ ‘areca cbovethon bom te mouth es_No__ ond rulers wheMsimu wa Lishe Bora Corre postening Incorrect stoning Nectamertasl neweliatocad goed ataeknert + et infont suckling ecto thot slow aoe ‘he, somaines pause Netwcingatal Netw eely Sling elle + oak fr uers whl otches inthe mau thrush) {0 BIRTH WEIGHT 1S THE YOUNG INFANT LESS THAN 1 WEEK? Yox__—No Determine infos weight ees han 2 kg? Between 2 kg ond 2.5 kos? 25g or more (tC HE YOUNG WANTS MUMZATION STATUS Cire immunizations needed ody Rotun for Bish immunization ace owe on (Date) Gweeks OWT OPT/FepBRib-1 [ASSESS CARE FOR DEVELOPMENT core problems + How do you ploy with your chia © How doyou commode wih 0 88 [ASSESS OTHER PROBLEMS: When attending fo o mother with a child from age 0 up to 5 years: * Greet the mother Listen actively Ask the mother what the child's problems are Explain the reason for examing the child Use the ‘Sick Child Recording Form’‘Msimu wa Lishe Bora For a child age 2 months up to 5 years: - Check for general danger signs + Assess, classify, and treat for cough or difficult breathing = Assess, classify, and treat for diarrhea and dehydration ~ Assess, classify, and treat for fever = Assess, classify and treat for ear infections = Check for malnultition and anaemia ~ Check for suspected symptomatic HIV infection = Check the child’s immunization and vitamin A supplementation status - Assess feeding if indicoted and counsel appropriately = Assess care for development if indicated and counsel appropriately - Check ~ Assess for other problems NB. Check for preventive activities and (messages) in the faciliies. A child who is not sick needs to be weighed and given other appropriate services. For a child aged up to 2 months: = Assess, classify, and treat for very severe disease = Assess, classify, and treat for jaundise - Assess, classify, and treat for eye infection ~ Assess, classify, and treat for diarrhea and dehydration - Assess for feeding problem or low weight - Assess breastfeeding = Check for low weight if infant - Check for immunization status = Assess for other problems less than 1 weekMsimu wa Lishe Bora NB. Check for preventive activities and (messages) in the facilities. A child who is not sick needs to be weighed and given other appropriate services. B. DEWORMING HOW TO DECIDE IF A CHILD NEEDS DEWORMERS Determine the Chil 's age and use it to decide if the child needs de-worming during that visit Ifthe child is 2 years or older and has not been de-wormed in the last 6 months, then de-worm the child as per the schedule below: GIVE MEBENDAZOLE Give 500mg Mebendazole as a single dose if: The child is 2 years or older, and The child has not had a dose in the previous 6 months Or give 400mg Albendazole as a single dose if The child is 2 years or older, and The child has not had a dose in the previous 6 monthseae Bier C. TREATMENT FOR COUGH Give an appropriate oral antibiotic For pneumonia and acute ear infection: First line- cotrimoxazole Second line- amoxycilin Prophyloxis for symptomatic HIV positive (+v) or HIV exposed child: cotrimoxazole Eanes Decne coe eer) a é re ae a eeed ee | Adut tablet ‘Syrup {80mg Trimethoprim 40mg Trimethopri ++200mg suiphamethoxazcle per Sm re 2 ‘5.0m rr yess cats ey Cer}sion wa Lishe Bora TREATMENT FOR COUGH FOR YOUNG INFANT Give first dose of intramuscular antibiotics Give first dose of both benzylpencillin and gentamycin intramuscular WEIGHT Foal BENZYLPENCILLIN Som than 2k Dose: 50, Caen i Caney ‘Add 2ml ‘Add 6m! To a vial of 600mg{ 1,000,000 units) of sterile sterile water to water to Add 2.1ml Add 3.6 ml 2m vial containing Sterile water OR Sterile water containing 2m vial =25mlat = 4.0 mlat 40mg=4ml at OR 80 mg 400,000 250,000 10mg/ml = 8ml at units/ml units/ml 10mg/ml 0.3 ml 0.1 mi 0.45 ml 0.2 ml Tm 0.2 ml 1.5 ml 0.4 ml 2mi 0.5 ml 2.5 ml 0.6 misimu wa Lishe Bora ive first dose of intramuscular antibiotics Give first dose of both benzylpencillin and gentamycin intramuscular CeucuN) eect eeu a [Add 2mi Add Gri of stele | Too vil of 600mg (1,000,000 oni) ‘Add 5 mis store water to vil of tre water woler 102ml viol | Add 2.1m Add 3.6 confining 1.2 milion units fo 2ml vil OR contining 80 mg | Sterie water OR Sterile water 12 milion ynit/éms = 200,000 conning (Srl Omg/mi) | = 2.5m ot = 4.0 mot ssl 40mg (4m of 400,000 250,000 10ma/m nits n/n 03 mi OA ml 2m 0.35 mis 0.45 ml 0.2 mi 0.3 ml 0.5 ms Vm 0.2m 0.4 ml 0.6 mis Val 02 mi 04 mi 0.75 mle 1.5 mis 0.4 ml 06 mi 0.85 mis 15 mis 0.4 mi 06 ml 1.0 mis 2.0 mls 05 mi 08 mi Tat mis 2.5 mis 06 mi 1.0 mlMsienu wa Lishe Bora NB. Treat the young infant to prevent low blood sugar * Ifthe child is able to breastfeed: ask the mother to breastfeed the infant If the child is not able to breastfeed but is able to swallow: give 20-50ml (10mi/kg) expressed breast milk or if neither of the above is available, give 20-50m| (10mI/kg) sugar water. To make sugar water: dissolve 4 level teaspoons of sugar (209) in a 200-ml cup of clean water. * Ifthe child is not able to swallow: give 20-50mI(1 OmI/kg) expressed breast milk or give 20-50mi(10ml/kg) sugar water by NG tube. * If low blood sugar is suspected: give 10%glucose Smi/kg by nasogastric tube same amount intravenously, To make 10% glucose mix one part of 50% glucose with 4 parts water for injection Low blood sugar (hypoglycemia) may be suspected in any infant or child who is convulsing or has loss of consciousness for which there is no obvious cause; has a rectal temperature of below 35.5° is drowsy or sweating, is lethargic, floppy or jittery . 1920 Mimo wa Lishe Bora D. TREATMENT FOR DIARRHOEA FIRST-LINE ANTIBIOTIC FOR SHIGELLA: CIPROFLOXACIN Cleat eal jaily for 3 doys sala ESlebialali. Give Metronidazole: Ifa child with dysentery has not improved on Ciprofloxacin by the second day Pan ytol aaeLeRCE Age or weight Tablet 200mg Syrup(200mg/5ml)Msimu wa Lishe Be FIRST-LINE ANTIBIOTIC FOR CHOLERA: ERYTHROMYCIN. SECOND-LINE ANTIBIOTIC FOR CHOLERA: CHLORAMPHENICAL Carel] Cone OU tent Cea ace ene eee co Age or weight Syrup Syrup 125mg/Sml 125mg/Sml 25 ml 2.5 mi 5.0 ml 5.0 ml PLAN C: TREATMENT OF SEVERE DEHYDRARTION Start IV fluid immediately. If the child can drink, give ORS by mouth while the drip is set up. Give 100mi/kg Ringer's Lactate solution or if not available normal saline as follows: | First give 30ml/kg In: | Le ee ae han Thourt 30 minutes* 5 hours 2.1/2 hours Infants{under 12months) Children (12 months up to 5 years) * Repeat once if radial pulse is still very weak or not detectable.Msienu wa Lishe Bora, + Reassess the child every 1-2 hours. If hydration siatus is not improving, give the IV drip more rapidly. + Also give ORS (about Smi/kg/houras soon as the child can drink; usually 3-4 hours infants) orl - 2 hours (children). + Reassess an infant after 6 hours and a child after 3 hours. Classify dehydration, then choose the ‘oppropriate plan (A, B or C) to continue treatment. PLAN B: TREATMENT OF SOME DEHYDRARTION WITH ORS rere rent ees aed ed 6- <10kg 10 - <12kg 12- <19kg 400-700 700-900 900-1400 Give in clinic recommended amount of ORS over 4-hour period (determine required amount over this period). + Use the child age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child’s weight by 75. + Ifthe child wants more ORS than shown ,give more + For infants under 6 months who are not breastfed, also give100-200ml clean water during this period. + Show the mother how to give ORS solution. = give frequent small sips from a cup (or spoon every 1-2 minutes for a child under 2 years). = check from time to time to see if there are any problems = ifthe child vomits, wait 10 minutes, then continue, but more slowly. - continue breastfeeding whenever the child wants = ifthe child’s eyelids become puffy, stop ORS and give plain water or breast milk. Give ORSMsirmu wa Lishe Bora ceccording to plan A when the puffiness is gone. * After 4 hours - reassess the child and classify the child for dehydration = select the appropriate plan to continue treatment. = begin feeding the child in clinic * Ifthe mother must leave before completing the treatment: - show her how fo prepare the solution at home. - show her how much ORS to give to finish 4-hour treatment at home. ~ give her enough ORS packets to complete dehydration, Also give her 4 packets as recommended in plan A * Explain the 4 rules of home treaiment. = give extra fluid ~ give zinc supplements ~ continue feeding and ~ When to return PLAN E: TREATMENT OF DIARRHOEA AT HOME * Explain the 4 rules of home treatment. ~ give extra fluid = give zinc supplements ~ continue feeding and ~ When fo go to the health focilityMima wa Lishe Bora Give extra fluid: ~ tell the mother to breast feed frequently and for longer at each feed. - ifthe child is exclusively breastfed, give one or more of the following: ORS solution, food based fluids (such os soup, enriched ji, and yoghurt drinks e.g. mala) fice or mashed bananas to provide potassium. Teach the mother how to mix and give ORS.Give the mother 4 packets of ORS to use at home. Show the mother how much fluid to give in addition to the fluid intake: = upto 2 years: 50 t0100 ml after each loose stool - 2 years or more: 100 to 200 ml afer each loose stool = tell the mother to frequently give small sips from a cup ~ if the child vomits, wait for 10 minutes, then continue, but more slowly. - continue giving extra fluid until the diarrhea stops Give zine supplements: Tell the mother how much zinc to give: = upto 6 months 1/2 tablet per day for 14 days = 6months or more, | tablet per day for 14 days. > for infants: dissolve the tablet in a small amount of expressed milk, ORS or clean water, in & small cup or spoon then give. = for children: tablets can be chewed or dissolved in « small amount of clean water and then givenMsinne wa Lishe Bora ZINC: give once dally for 14 doys Teblet (20mg Toblet (10a! 0 2 1 a 5 Age oe EST *+ Remind the mother how to give the zinc supplement for the 14 doys. + Continue feeding and ‘| When to return. GIVE MULTIVITAMIN/ MINERAL SUPPLEMENT FOR PERSISTENT DIARRHOEA *+ Give dolly for two weeks ie 2 months to 6 months (4-8 kg) 6 months to 2 years (8-12 kg) 2 years to 5 years (12-19 ka)Msimu wa Lishe Bora E, TREATMENT FOR ANEMIA + Give Iron and Folate Give one dose at 6 mg/kg of Iron daily for 14 days. NB. Avoid Iron in a child known to suffer from sickle cell anaemia. ‘Avoid foliate until 2 weeks after child has completed the dose of sulfa based drugs. er eee Iron tablet |f Folate tablet an ert) eer ry ee ey rect) Cer) 2 upto 4months 4 We (4:6kg) ‘4 upto 12months | va 1 (6-10kg) T2months io 3years | 1/2 tablet We 1 (10-14kg) SyearsupioSyeers | 1/2 tablet 2 1 (14-19 kg)Maimu wa Lishe Bora F MALARIA TREATMENT SCHEDULE GIVE AN ORAL ANTIMALARIAL ~ First-line Antimalarial: Artemther + Lumefantrine (not recommended for infants < 5 kg) + Second-line Antimalarial: Oral quinine (also Ist line for infants < 5 kg) If Artemther + Lumefantrine (ACT):Give 6 doses as shown in the chart below If Oral quinine: Give 3 times daily for seven days. doy 1 give | after 8 hrs give doy 2 and 3 give every 12 hours 5-14kg (3 years) 1 1 15-24kg(3-9 years)| 2 2 2 QUININE (ai 10mg/kg) Give 8 hourly for seven days OTe os ad aL Eee) ees 2 months up to 4 months | 4<7kg) : 7 4 months up to 12 months (7 <12kg) V4 V2 12 months up to 4 years (12<16kg) v2 3/4 4 years up to 5 years (16 < 19kg) 3/4 128 sim wa Lishe Bora Mosquito Nets: If mosquito nets are available issue the ITN to the mother for the child’s use and explain thal the ITN prevents the child from getting infected with malaria at nightime and the child must sleep under a rected mosquito net every night G. FEEDING CHILDREN WITH LOW WEIGHT AND DURING ILLNESS Establish child’s feeding practices by caregivers presenting with sick children or children with low weight and counsel them on how to feed children with low weight as well as feeding children during illness. Establish child’s feeding practices by the caregiver ee ee ee Establish whether the child is served on his/her own plete. Set ee ee Find out how frequently the child is fed Corrective action oe eae at aomarmeans feeding. Explain body building, energy giving, and protective foods. Body building foods respo! Wien ere nr oer eas Mr ert er aoe ee ag mene eet te od Encourage incre Se oe eee ee ee a ee ean Je child's usval daily feeds up to 2 weeks ofr illness Paeceereee merase nor et eer Cor ere epee ete OR nee a as‘Msimu wa Lishe Bora: PREVENTIVE ACTIVI IES AND MESSAGES. ENSURING PROMOTION OF HOLISTIC HEALTH CARE TO CHILDREN IN KENYA REMEMBER 1) To immunize the child fully by one year 2) Towash your hands before handling food and after visiting the toilet, 3) To follow health workers advice about treatment and referrals. 4) To talk and play with your child 5) To prevent child abuse ond accidents 6) To use safe drinking water 7) To provide safe ploying environment for a child 8) To keep a way objects, articles or items that may harm the child. 9) That your child sleeps under insecticide treated Mosquito net every night. 10) That pregnant woman visits a health facility at least four times for antenatal care and the first Visit must be as soon as she knows she is pregnant. Also fo sleep under ITN. 29‘Msimu wa Lishe Bora “SERVICE TO CHILDREN IS SERVICE TO THE NATION’ ‘A. Expectant Woman Package Nutrition Package For Expectant Mothers Actions for health workers enna ee eee el Pee eee eer ace eieoaes bolanced diet rich in vitamins and ees operas i Peel ee ee ee eer) ere as cee cree ay ee eet crea eee ee ae (Feso4) tablets three times o Media lcs Ce SO a eee Saleh esto Peer ee phrase Pea nore cy Cee ed ited Heceoctienctetet Hieseertipipntenet ee Pega epeesra aay to the nearest higher level of Sa ee eee eae een ‘abnormalities such as oedema,simu wa Lishe Bora B. 5 - LT schedule during focused antenatal care visits First Ist TT DOSE Dose is en immunological trigget No protection from tetanus Pregnancy | (given from 4th 6th | & does not confer immunity | at birth Months ive. 3rd trimester) ‘2nd TT DOSE Protection from maternal tetanus| Protection at birth for 90% (given 1 month after TT1 | at delivery Babout 1-3 yeors | of neonates i.e. from 5th — 8th Month} from tetanus in general Second | 3rd .T DOSE Immunity boosted for 5 years | Protection at birth is Pregnaney | (given anytime between approximately 100% 4th & 8th Month) Third 4th TT DOSE Immunity boosted for 10 years | Increased protection at Pregnancy | (given anytime between birth against tetanus 4th & BihMonth) Fourth _| 5th T.T DOSE & last dose | Immunity boosted for 20 years | Increased protection at Pregnancy | (given anytime between birth against tetanus 4th & 8th Month) Subsequent | No more TT doses Immunity adequate for the rest_| Adequate protection at Pregnancies) of porents life birth for neonate 3132 Msirnu wa Lishe Bora Protect mothers and children from maternal and neonatal tetanus Key elements for effective FANC tetanus vaccination: For the success of the 5 T.T vaccinations: + Pregnant women must attend ante natal clinics early enough + Pregnant women make multiple visits to the antenatal clinic + Antenatal clinies provide 7.T vaccination c. PMTCT + Counsel mother on HIV. + Offer HIV testing fo the pregnant women. * Rapid HIV tests available and give results in less than one hour. + For HIV positive pregnant women; * Counsel them on infant feeding choices. Available choices are either: exclusive breast feeding (not even giving water) or exclusive formula feeding. ‘+ Must avoid mixed feeding. * Counsel them on the need to deliver in a hospital or health facility to reduce the risk of MTCT and receive ARVs at onset of labour (mother) and after birth (baby). + Counsel them on other infections, danger signs condom use and contraceptive options + Should be linked to care, treatment and support to enhance follow-up. * Give AZT from 28 weeks. * Baby Nevirapine should be given within 72hrs of birth + Counsel on Family Planning methods and dual protection especially for HIV+ ve women(simu wa Lishe Bora D. Lactating Mother Nutrition Package for Lactating Mothers ost partum supplementation Mother's diet Actions for health workers E. Postpartum care + Counsel the mother on: - When to come for postpartum check up: immediately, 48 hours, 2 weeks, 4- 6 weeks, 6 months and one year. ~ To visit well baby clinic for the child’s immunization - Follow-up for babies exposed to HIV. ~ To choose @ postpartum family planning method. F. Family planning * Inform clients about the methods available, how they work, advantages, limitations, side effects, how to use them, re-supply and follow-up. * Specifically * Counsel the client and help her/him to choose the appropriate method * Give client instructions on how to use the method and discuss the common side effects * Counsel the client on the need for follow-up visits fo the health facility 8Ear Bera Afya Leo ni Uzima Kesho